By: Melissa Gerson, LCSW
An Intensive Outpatient Program (IOP) is a treatment option that serves as a step-down from a residential or partial hospitalization program, or a step-up from standard outpatient therapy. IOP is an opportunity for individuals to engage in their daily lives (i.e. participate in work, school or community and social activities) while working toward treatment goals in a supportive and structured environment. For those who are phasing back into their everyday lives after a residential stay or partial hospitalization program, IOP is an opportunity to restore independence. For those who are seeking a higher level of care than a traditional outpatient program, IOP provides more points of contact with a treatment team and peers while enabling participants to participate in the activities of daily life, as appropriate.
What is the time commitment for an Intensive Outpatient Program?
Traditional IOP programs will require between 6-15 hours of treatment per week over the course of 3-5 days. The intensity (i.e. 3 vs 5 days) depends on the individual needs of the client. Some programs run IOP in the evening hours (5-8pm or 6-9pm) while other programs may offer more flexibility with daytime options for those whose schedules allow.
What does treatment look like on a day to day basis?
IOP is an opportunity for many to “jump start” treatment. In other words, in a short amount of time, programs work to redirect and shape behaviors, change long-standing patterns and support new strategies for stable eating. Typical expectations for an IOP suggest a 50% reduction in symptoms within 8 weeks. For those who are stepping down from more intensive settings, IOP may be structured differently…. to slowly expose the individual to more and more independence until the client feels confident to move on.
IOP hours typically include group therapy, supported meals, individual therapy and family work (if indicated). Intervention strategies and objectives vary by disorder. For example, for AN clients, it’s important to see movement toward more varied and balanced eating along with a clear trajectory of weight restoration. With bulimia, an ideal program will focus in on food exposure, variety and skills for managing/coping with urges to binge or purge. For binge eating disorder, an IOP program would be geared around skill building, developing self-awareness, mindfulness, distress tolerance, and emotion regulation.
To determine if an individual is appropriate for an IOP program, clinics will typically utilize standards established by the American Psychiatric Association. Below is a basic chart – based on the APA standards – that we use at our Columbus Park IOP. It represents some factors we consider when establishing the appropriate level of care for individuals coming into our program.
|Standard Outpatient Criteria||Intensive Outpatient Program Criteria||Partial Hospital/Residential/Inpatient Criteria|
|Medically stable/cleared by Medical Doctor||Medically stable/cleared by MD/ frequent follow up required||Medical instability|
|With guidance, pt is capable of creating one’s own meal structure||External structure needed to eat or gain weight||Supervision required during/after meals|
|Fair to good motivation to recover||At least fair motivation to recover||Poor motivation to recover|
|Co-morbidities (i.e. depression, anxiety) may have some limited impact on functioning||Co-morbidities (i.e. depression, anxiety) have high impact on functioning||Psychiatric condition requiring hospitalization|
|Suicidality, if present, is passive (no active plan or intent to take one’s life)|| |
Suicidality, if present, is active and more structure/points of contact needed. Possible suicide attempts in past.
|Suicidality is active w/intent and plan and unable to contract for safety|
|Some ability to control exercise||Some ability to modulate exercise||Structure needed to prevent compulsive exercise|
|Some social support||Limited social support||No support available to add structure outside of treatment|
Could you or a loved one benefit from an IOP program? Most insurance carriers list local facilities that are covered in their networks. You can either look on your carrier website or call a representative who can walk you through the covered facilities. It’s also great to search online since most programs will have detailed information on their websites. You’ll want to get a sense of the overall program philosophy, treatments used, structure and schedule. Ask for a tour or informational meeting to get more of a sense of the setting. Be an educated consumer and ask questions. You have a right to know what you’re getting into even before you go in for an initial assessment.
About the Author: Melissa Gerson, LCSW is the Founder and Clinical Director of Columbus Park, Manhattan’s leading outpatient center for the treatment of eating disorders. As a comprehensive outpatient resource for individuals of all ages, they offer individual therapy, targeted groups, daily supported meals and an Intensive Outpatient Program (IOP). Columbus Park uses the most effective, evidence-based treatments like Enhanced CBT and Dialectical Behavior Therapy (DBT) to treat binge eating, emotional eating, bulimia, anorexia and other food or weight-related struggles. They track patient outcomes closely so they can speak concretely about their success in guiding our patients to recovery.